Diagnosis: Digestive System/Gastrointestinal
Treatment: Inpatient Hospital

This is a patient with an esophageal foreign body that required removal in the operating room. He presented to the emergency department (ED) with a concern for a swallowed coin. Vital signs were stable. He underwent an uncomplicated esophagoscopy with foreign body removal. There were no operative or perioperative complications. He was discharged home. At issue is the medical necessity of an inpatient stay.
The health plan's determination is upheld. The child had stable vital signs and no concern for any serious aero-digestive injury. He underwent an uncomplicated procedure without any peri-operative concerns. He could have been managed at a lower level of care than inpatient. Esophagoscopy with foreign body removal in an otherwise healthy child is typically done under an ambulatory status. In this case, there were no airway concerns. The child had a normal esophagoscopy after the penny was removed. He did not have immediate peri-operative complications. There was no medical documentation showing that inpatient status was medically necessary.